Lost Sale/Lost Revenue Questionnaire

OMB No. 3117-0016/USITC No. xx-x-xxx; Expiration Date: 6/30/2017
(No response is required if currently valid OMB control number is not displayed)

LOST SALES AND LOST REVENUE SURVEY
INVESTIGATION TITLE
This survey must be received by the Commission by DATE
See last page for filing instructions.
The information called for in this survey is for use by the United States International Trade Commission in connection
with its countervailing duty/antidumping investigation(s) concerning #abbrproduct from #ctrysubs (inv. No. 701/731-TAxxx (Preliminary)). The information requested in the survey is requested under the authority of the Tariff Act of 1930,
title VII. This report is mandatory and failure to reply as directed can result in a subpoena or other order to compel the
submission of records or information in your possession (19 U.S.C. § 1333(a)). Further information on this survey can be
obtained from ECONOMIST (202-205-xxxx, NAME@usitc.gov).

Name of firm
Address
City

State

Zip Code

Website
Has your firm purchased #abbrproduct (as defined on next page) at any time since January 1, #bopyear?

NO

(Sign the certification below and promptly return only this page of the survey to the Commission)

YES

(Complete all parts of the survey, and return the entire survey to the Commission)

Return questionnaire via the U.S. International Trade Commission Drop Box by clicking on the
following link: https://dropbox.usitc.gov/oinv/. (PIN: XXXX)
CERTIFICATION
I certify that the information herein supplied in this survey is complete and correct to the best of my knowledge and belief and
understand that the information submitted is subject to audit and verification by the Commission.
By submitting this certification I also grant consent for the Commission, and its employees and contract personnel, to use the
information provided in this survey and throughout this proceeding in any other import-injury proceedings conducted by the
Commission on the same or similar merchandise.
I, the undersigned, acknowledge that information submitted in response to this request for information and throughout this
investigation or other proceeding may be disclosed to and used:
(i) by the Commission, its employees and Offices, and contract personnel (a) for developing or maintaining the records of this or a
related proceeding, or (b) in internal investigations, audits, reviews, and evaluations relating to the programs, personnel, and
operations of the Commission including under 5 U.S.C. Appendix 3; or
(ii) by U.S. government employees and contract personnel, solely for cybersecurity purposes. I understand that all contract
personnel will sign appropriate nondisclosure agreements.
Name of Authorized Official

Title of Authorized Official

Date

Signature

Phone

Email address

Business Proprietary
Lost Sales and Lost Revenue Survey- #ABBRPRODUCT

Page 2

GENERAL INFORMATION
Background.--This proceeding was instituted in response to a petition filed on DATE, by COMPANY
NAME, CITY, STATE. Countervailing/antidumping duties may be assessed on the subject imports as a
result of these proceedings if the Commission makes an affirmative determination of injury, threat, or
material retardation, and if the U.S. Department of Commerce (“Commerce”) makes an affirmative
determination of subsidization/dumping. U.S. producers of #abbrproduct have provided the USITC with
allegations about sales or revenue that they have lost due to competition from imports of #abbrproduct
from #countries. One or more domestic producer(s) have named your firm in such an allegation.
#abbrproduct covered by these investigations is . . . COMMERCE SCOPE LANGAUGE
Reporting of information.-- If information is not readily available from your records, provide carefully
prepared estimates.
Confidentiality.--The data furnished in response to this survey that reveal the individual operations of
your firm will be treated as confidential by the Commission to the extent that such data are not
otherwise available to the public and will not be disclosed except as may be required by law (see 19
U.S.C. 1677f). Such confidential information will not be published in a manner that will reveal the
individual operations of your firm; however, general characterizations of numerical business proprietary
information (such as discussion of trends) will be treated as confidential business information only at the
request of the submitter for good cause shown.
Release of information.--The information provided by your firm in response to this survey, as well as
any other business proprietary information submitted by your firm to the Commission in connection
with this proceeding, may become subject to, and released under, the administrative protective order
provisions of the Tariff Act of 1930 (19 U.S.C. § 1677f) and section 207.7 of the Commission’s Rules of
Practice and Procedure (19 CFR § 207.7). This means that certain lawyers and other authorized
individuals may temporarily be given access to the information for use in connection with this
proceeding or other import-injury proceedings conducted by the Commission on the same or similar
merchandise; those individuals would be subject to severe penalties if the information were divulged to
unauthorized individuals. Please also retain a copy of the final document that you submit.
Contact information.--Please identify the responsible individual and the manner by which Commission
staff may contact that individual regarding the confidential information submitted in this survey. This
may or may not be the person whose signature is at the bottom of page 1.
Name
Title
Email
Telephone

Business Proprietary
Lost Sales and Lost Revenue Survey- #PRODUCT

Page 3

PURCHASE INFORMATION
1. Purchases.—Report your firm’s total U.S. purchases of #abbrproduct. Estimates are acceptable.
Item

2013

2014

Purchases of #abbrproduct produced
in--

2015

Quantity (in #units)

United States
#ctrysubA
#ctrysubB
#ctrysubC
All other countries:1
Sources unknown
Total purchases
1

0

0

0

Please identify these countries:

2. Changes in purchasing patterns.— Please indicate how the shares of your firm’s purchases of
#abbrproduct from different sources have changed since January 1, #bopyear.
Source of
purchases
United
States

#ctrysubA

#ctrysubB

#ctrysubC

All other
countries
Sources
unknown

Did not
purchase

Decreased Increased

Constant

Fluctuated

Explanation for trend

Business Proprietary
Lost Sales and Lost Revenue Survey- #PRODUCT

Page 4

3. Major purchasing factors.--Please list, in order of their importance, the main factors your firm
considers in deciding from whom to purchase #abbrproduct.
1.
2.
3.
Please list any other factors that are very important in your purchase decisions:

4. Purchasing subject imports rather than domestic products.—
(a)

Since January #bopyear, did your firm purchase imports of #abbrproduct from #ctrysubs
instead of U.S.-produced #abbrproduct? Respond for each subject country.

Source

Yes
(also respond to parts (b) and (c))

No
(If “No” for all countries, skip to next
question)

#ctrysubA
#ctrysubB
#ctrysubC
(b)

If you responded “Yes” to part (a), was the imported product priced lower than the
domestic product?
Source

Yes

No

#ctrysubA
#ctrysubB
#ctrysubC
(c)

If you responded “Yes” to part (a), was price a primary reason for purchasing subject
imports rather than domestic product?

Source

#ctrysubA
#ctrysubB
#ctrysubC

Yes

If Yes, estimate the quantity
of imports purchased instead
of domestic product since
January #bopyear
(in #units)

No

If No, please indicate the
reason your firm purchased
imports instead of domestic
product

Business Proprietary
Lost Sales and Lost Revenue Survey- #PRODUCT
5.

Page 5

U.S. producers and import competition.—
(a)

Since January 1, #bopyear, in connection with a sale or offer to sell #abbrproduct to
your firm, did U.S. producers reduce their prices of domestically produced #abbrproduct
in order to compete with lower-priced imports of #abbrproduct from the subject
countries? Respond for each subject country.
Source

Yes (also respond to
question part (b))

No (If “No” for all countries,
skip to next question)

Don’t know

#ctrysubA
#ctrysubB
#ctrysubC
(b)

If your firm responded “yes” to any of the above countries, please provide an estimate
of the reduction in U.S. producers’ prices, and any additional explanations, such as
timing (e.g., months/years), frequency of price reductions, or other market/competitive
factors.

Source

Estimated
reduction in U.S.
prices
(percent)

#ctrysubA

%

#ctrysubB

%

#ctrysubC

%

Additional explanation, including such information as
timing (e.g., months/years), frequency of price
reductions, or other market/competitive factors

6. Method of purchase--Please provide a general description of your firm’s method(s) of purchase
(e.g., individual purchase, contract, bids, Internet purchases, etc.) for #abbrproduct.

7. Other explanations--Please provide any additional comments in this box.

Business Proprietary
Lost Sales and Lost Revenue Survey- #PRODUCT

Page 6

OMB INFORMATION
7. OMB statistics.--Please report the actual number of hours required and the cost to your firm of
completing this survey.
Hours

Dollars

The questions in this survey have been reviewed with market participants to ensure that issues of
concern are adequately addressed and that data requests are sufficient, meaningful, and as limited
as possible. Public reporting burden for this survey is estimated to average 4 hours per response,
including the time for reviewing instructions, gathering data, and completing and reviewing the
survey.
We welcome comments regarding the accuracy of this burden estimate, suggestions for reducing
the burden, and any suggestions for improving this survey. Please attach such comments to your
response or send to the Office of Investigations, USITC, 500 E St. SW, Washington, DC 20436.

HOW TO FILE YOUR SURVEY RESPONSE
Please do not attempt to modify the format or permissions of the survey document.
Please submit the completed survey using one of the methods noted below. If your firm
is unable to complete the MS Word survey or cannot use one of the electronic methods
of submission, please contact the Commission for further instructions.
• Upload via Secure Drop Box.—Upload the MS Word survey along with a scanned copy of the signed
certification page (page 1) through the Commission’s secure upload facility:
o
o
o

Web address: https://dropbox.usitc.gov/oinv/
Enter Investigation: Select “INVESTIGATION-SPECIFIC MENU ITEM” in the drop down menu
Pin: INVESTIGATION-SPECIFIC PW

• E-mail.—E-mail the MS Word survey to NAME@usitc.gov; include a scanned copy of the signed
certification page (page 1). Submitters are strongly encouraged to encrypt nonpublic documents that are
electronically transmitted to the Commission to protect your sensitive information from unauthorized
disclosure. The USITC secure drop-box system and the Electronic Document Information System (EDIS)
use Federal Information Processing Standards (FIPS) 140-2 cryptographic algorithms to encrypt data in
transit. Submitting your nonpublic documents by a means that does not use these encryption algorithms
(such as by email) may subject your firm’s nonpublic information to unauthorized disclosure during
transmission. If you choose a non-encrypted method of electronic transmission, the Commission warns
you that the risk of such possible unauthorized disclosure is assumed by you and not by the Commission.
If your firm did not purchase this product, please fill out page 1, print, sign, and submit a scanned copy
to the Commission.